Robert E. Reiter, MD, presented “Can MRI Be Used to Select Patients for Focal Therapy or To Guide Therapy?” during the 29th Annual International Prostate Cancer Update on January 24, 2019 in Beaver Creek, Colorado.
How to cite: Reiter, Robert E. “Can MRI Be Used to Select Patients for Focal Therapy or To Guide Therapy?” January 24, 2019. Accessed Nov 2024. https://grandroundsinurology.com/can-mri-be-used-to-select-patients-for-focal-therapy-or-to-guide-therapy/
Can MRI Be Used to Select Patients for Focal Therapy or To Guide Therapy? – Summary:
Robert E. Reiter, MD, reviews data comparing tumor analysis as seen on MRI and fusion biopsy to whole-mount histology following radical prostatectomy. He discusses whether evidence supports the use of MRI for determining patient eligibility and planning for focal therapy.
Abstract:
MRI is a well-established technology for prostate cancer detection, biopsy guidance, and informing management. However, there is not yet a consensus as to whether or not MRI or MRI-targeted biopsies are sufficient for guiding focal therapy, patient selection, and treatment planning.
The generally-established focal therapy eligibility criteria include the presence of clinical stage T2c or less, serum PSA of 20 ng/mL or less, and a PI-RADS region of interest (ROI) Grade 3 or higher visible on MRI.
In an assessment of focal therapy eligibility, out of patients who were eligible according to multiparametric MRI and targeted biopsy findings, a significant number were found to be ineligible based on whole-mount histology after radical prostatectomy. This calls into question the sensitivity and specificity of fusion biopsy for predicting focal therapy eligibility.
The discordance of fusion biopsy and whole-mount tumor analysis could be due to the limited sensitivity and detection rates of MRI. The mean difference in size between ROIs seen on MRI and whole-mount tumors is about 15mm. This shows that MRI significantly under-detects the dimensions of tumors, and is an insufficient tool for planning ablation.
About the International Prostate Cancer Update
The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Reiter presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.
ABOUT THE AUTHOR
Robert E. Reiter, MD, MBA, is the Bing Professor of Urology and Molecular Biology and Director of the Prostate Cancer Treatment and Research Program at the David Geffen School of Medicine at the University of California, Los Angeles. He is currently the Principal Investigator of UCLA’s SPORE (Specialized Program in Research Excellence) program, a $12 million research grant from the National Cancer Institute to develop new diagnostic and treatment options for men with prostate cancer. Dr. Reiter’s clinical interests include robotic surgical management of prostate cancer and the use of both MRI and molecular imaging tools to manage this disease. His research is focused on the development of novel antibodies for both treatment and imaging of prostate cancer, as well as on the role of epithelial to mesenchymal transition in castration and treatment resistance. Dr. Reiter completed his undergraduate studies at Yale University and earned his medical degree at Stanford University Medical School.
